Archive for July, 2011

What are the challenges facing registrars and newly qualified public health consultants today? What training opportunities are there to fully maximise employment potential? These were the questions raised during a session at the FPH Annual Conference. Addressing the concerns and speaking on a range of topics were a varied panel including Judy Jones, Department of Health, Anna Middlemiss, specialty registrar Yorkshire & Humber, Trudi Kemp, a public health consultant from St Georges Healthcare NHS Trust, Brendan Mason, training programme director in Wales, and Michael Bannon, lead postgraduate dean. FPH’s academic registrar, David Williams, chaired the session.

Judy Jones asked how well we have responded to organisational change, system reform, policy drift, fragmentation and divergence. Stressing the importance of now needing to think about things differently, due to the current radical shifts in organisation, she highlighted how the current changes affect everyone and not just those coming out of training programmes.

Trudi Kemp talked about acute trust placements, emphasising that they are not uncommon, Usually specialist placements, taken post-part A and often post-part B exams, they allow registrars to work with clinical teams in their natural habitat, taking the registrar out of their comfort zone and allowing them to function at a senior level.

Anna Middlemiss related her experiences of her placement with West Yorkshire Police in their Drugs and Offender Management Unit. She explained how it provides an opportunity to practise public health in a completely different environment, as well as an opportunity to work at a high level and gain first-hand experience of another public health organisation. Sometimes it was important to do something completely different in order to appreciate the public health skills you have.

David Williams concluded that it was clear that there was a lot that could be done with the systems we already have in place, but that we need the imagination and creativity to do it.

This session at the FPH conference was led by Dr Sarah Aitken, Dr Alison Talbot-Smith and Mrs Clare Wichbold, all from Herefordshire PCT – an early adopter of the white paper proposals, they have already health and wellbeing board.

The health and wellbeing board must provide effective leadership, an integrated commissioning role, whilst understanding the comprehensive and wide ranging needs across the entire community. It must establish clear priorities and set strategy accordingly to improve all sectoral outcomes.

Clinical commissioning groups (CCG) will not have a direct link to the local authority. But this is where the role of the health and wellbeing board is important as it will have the power to appeal any decision that the group takes. Herefordshire has recognised the importance of having a circumscribed role for a public health consultant to sit on the CCGs. Herefordshire has conducted a county-wide joint strategic needs assessment involving the CCG which has been important.

As part of the session Mrs Wichbold conducted an exercise where members of the audience were handed a local paper and asked to identify the articles affecting population health and wellbeing. After identification, they were placed on the ladder of intervention (Nuffield Council of Bioethics, 2008). This was used by Herefordshire as part of engaging the wider public and community in identifying population health and wellbeing; it was also used with a variety of health professionals, environmental health professionals amongst others. This showed the audience the large number of incidents/reports that actually do relate to population health such as environmental, epidemiological and mental health.

Herefordshire, as an early adopter, is establishing a workable system. It remains to be seen if all areas can produce an effective system particularly with the number of CCGs which may be established across the larger regions, and how these will interact with the health and wellbeing boards.

It’s time to take a new approach to mental health and wellbeing. This was the basis of the session led by Sarah Stewart-Brown, FPH’s Mental Health Committee Chair, with Ruth Hussey and Jude Stansfield co-presenting, and who made a clear case for embedding mental health and wellbeing within public health action.

Although patients and the public have always appreciated the link between mental and physical health, the health profession has been slower to accept that improving the first aspect could help prevent physical illness – ‘your body is your subconscious mind’. One alarming point made to support this, is that research has shown that an individual with a psychotic disorder could die up to 25 years earlier, compared to the average.

The session also looked at the comprehensive case study being undertaken in the North West of England, which involves working with patients, the public, and organisations, and looks at the various aspects of mental health and wellbeing affecting people’s lives.

Mental health and wellbeing is affected by many factors including environmental, social and ‘lifestyle’. It covers a range of aspects: self esteem and confidence, emotional wellbeing (eg. joy, happiness, vigour and energy, life satisfaction, optimism and sense of humour), agency autonomy, self-belief, motivation and self-care.

Promoting positive parenting was seen as important, as children’s formative years have a huge influence on their future mental and physical health and wellbeing. To support this, children and parents should have access to a variety of programmes, including school and workplace-based programmes, psychological therapies, and support for general lifestyle changes.

When mental health is discussed, it is normally in a negative way; and this needs to change to encourage a more positive dialogue which supports the promotion of good mental health, and positive individual and community approaches to environmental and social issues to create positive outcomes. Health inequalities were also an important consideration; where there is low educational standards, poverty, a disadvantaged environment, the incidence of a negative mental health outcome is higher.

If you improve the population’s mental health and wellbeing an improvement will be seen in the physical health of that population. This is a very important aspect of public health and must be recognised and acted upon, as this will affect the health of the population in the future. It’s a huge endeavour, but health professionals need to undertake a new approach and recognise the advantages of taking this forward.

By Dr John Middleton, Director of Public Health for Sandwell and FPH Vice President

A packed lecture theatre of over 150 health and local authority professionals, gathered to hear Councillor David Sprason, Councillor Ernie White and Dr Peter Marks about their work in Leicestershire County Council, and from Councillor Ann Jaron and Dr John Middleton from Sandwell Council. The session was designed to contrast urban and rural council public health activities, and to discuss the risks and possibilities presented by the new public health in local authorities. Major examples of joint health and council activity for health improvement including drugs and alcohol services, cardiovascular disease reduction and reducing teenage pregnancy were shared. The move by public health into local authorities was viewed as a major opportunity to improve the health of the people we serve.

The public health community needed to shake off any nerves about the move and get involved with the action in local authorities. Public health specialists need to trust their elected members as potentially powerful advocates for health related policies. Councillors needed to see inequality in health as an important policy consideration, an issue of civic pride – alongside traditional concerns like crime and antisocial behaviour.

Public health has developed tools for health impact assessment, for addressing health inequalities, for risk stratification, for modelling and priority setting which are needed in the new context to support council decision making.

The meeting saw health and wellbeing boards, joint health needs analysis and the joint health and wellbeing strategy as major tools for health action between the council and clinical consortia. Councils needed to take a lead role in respect of overall the health strategy, particularly where there they cover more than one clinical consortium.

Although panellists believed independence was important to giving scientific and credible advice – they also felt that accountability was equally important. Public health professionals need to work with elected members and give them the bullets to fire for improving public health.

Public health professionals could also contribute to the local authority agenda – bringing to councils expertise in research, in systematic reviews and knowledge management and also in workforce planning, training and development of specialist and practitioner staff.

The Local Government Group believes it is for local authorities to decide the nature of their local structures. The FPH and the Association of Directors of Public Health think DPHs should be top-table appointees. Participants reached a strong conclusion that DPHs should report to the chief executive of councils. This was necessary to ensure public health input to all council policies – including ‘people’ policies around social care and education but also the ‘place’ policies of environment, housing and transport and economic development

There is much that is positive about the move to local authorities and this very upbeat meeting concluded with Councillor Sprason stating his DPH was absolutely key to his council’s ability to deliver better health for Leicestershire people.

Disclaimer

The aim of this blog is to encourage discussion and debate on public health issues. The views expressed here are the personal views of authors, and the content does not reflect the official position of the Faculty of Public Health. However, discussion generated here may be used to influence the development of organisational policy.